Setting up a patient navigator program to serve low-income and minority cancer patients requires intensive community involvement and thorough training of the navigators, researchers report in the journal CANCER (2206;107:2669–2677). David C. Khan, MD, and colleagues from Centinela Freeman Regional Medical Center in Inglewood, California, describe their experiences developing a program they say has met with success in their community of primarily low-income Hispanics/Latinos and African Americans.
Their program ultimately provided 22 lay navigators who served 75 cancer patients in the first 7 months of operation. Navigators helped patients with a range of tasks, including transportation to appointments, finding ways to pay for care, connecting patients with community support services and other resources, and facilitating communication with physicians and other providers. Navigator interactions with patients were reviewed regularly by hospital staff by means of anonymous patient surveys and chart review to assure patient needs were being addressed.
Training for the navigators consisted of an initial 6-hour course and ongoing discussions with hospital staff. Topics covered included the navigator role, barriers to care, recordkeeping, communicating with cancer patients, dealing with the emotional needs of cancer patients, and privacy concerns.
Another key component was building community support for the program. The organizers recruited a community advisory board to provide insight on patient needs and barriers to care in the hospital's diverse community of service.
Clinical trials were a case in point, said Khan, a radiation oncologist and co-principal investigator for the study. One of the program's goals was increasing minority enrollment in clinical trials.
“When we asked the group how they viewed clinical trials, the initial response from the minorities on the board was that it was experimentation, and they didn't want any part of that—à la Tuskegee,” said Khan. “But when we talked to the Caucasian members of the advisory board, they said they wanted clinical trials because they're cutting edge. It illustrated a very different view of how clinical trials were seen by patients at large.”
Having this knowledge allowed program organizers to focus on the importance of clinical trials in training sessions with navigators. Sessions also included detailed discussions of how chemotherapy and radiation work and why integrating the two treatment modalities can be important, Khan said.
The report could serve as a guide for other clinicians looking to establish similar programs, says Angelina Esparza, RN, American Cancer Society (ACS) Director of Quality of Life and Information and head of the ACS's own Patient Navigator Program. That program has trained more than 190 ACS staff navigators to date and established standards and guidelines for operations. Eighty of these navigators have been placed in hospitals, clinics, or cancer treatment facilities with large proportions of uninsured or Medicaid patients.
In general, patient navigator programs vary widely throughout the country, Esparza noted, and there is no standard, defined scope of work for navigators, although many (including the ACS and the National Cancer Institute) are working to investigate the effectiveness of these programs and develop a general scope of activities. Khan's project delineates the navigators' duties very clearly and differentiates them from roles filled by other hospital staff, like case managers and clinical social workers. The focus on navigator training is another strength, she said.
Khan's group is in the process of evaluating the success of its navigator program. Anecdotally, he said, patient satisfaction as measured through surveys was high. His group also is developing a way to compare outcomes between patients who did and did not choose navigators.
All those efforts will help refine patient navigator programs, he said.
“I think navigation is going to become an increasingly important part of cancer care in general … and it's programs like this which will define how navigation is performed in the future,” said Khan. “Everyone has a different model, every community has different needs and a different set of beliefs that may inhibit optimal cancer care.”.